Dementia/Alzheimer's Disease

Dementia is defined by the National Institutes of Health (NIH) as “the loss of brain function that occurs with certain diseases.”
Alzheimer’s disease is a form of dementia that gradually becomes more severe over time. Symptoms of dementia can include changes in emotional behavior, difficulty with language, loss of memory, and changes in thinking and judgment. Alzheimer’s sufferers may experience these symptoms plus more troubling signs such as getting lost in familiar areas, loss of interest in previously enjoyed activities, as well as difficulty reading, writing, and completing basic tasks. Someone with Alzheimer’s disease may also forget events of their own life or no longer be able to recognize family and friends.[1]

There currently are no cures for Alzheimer’s disease (AD). Treatments involve slowing the progression of the disease and managing the symptoms. Medications are not always effective. Researchers are now exploring ways in which the human-animal bond may be utilized to mitigate the symptoms of dementia and AD.

Dementia has two victims, the person who is diagnosed (the care recipient) and the person taking care of the recipient (the caregiver). Research has indicated that the human-animal bond can have a role in improving quality of life for both the care recipient and the caregiver. For the care recipient, studies have found that mental activity can play a protective role against cognitive degeneration [2]. Animals provide such stimulation, whether it is helping someone to be more mobile, giving companionship, and helping maintain a social sphere. On
the other hand, someone in the role of the primary caregiver for an Alzheimer’s patient can be vulnerable to psychological distress such as depression and anxiety. The presence of a companion animal may help the caregiver cope with the changes in their life as a result of the diagnosis of dementia and/or AD [3]

Studies have found that mental activity can play a protective role against cognitive degeneration such as dementia and AD [4]. Animals provide stimulation, whether it is helping someone to be more mobile, giving companionship, and helping maintain a social sphere. Studies suggest that animal presence, even something as seemingly benign as an aquarium in a dining room, can be beneficial for those with dementia and AD.

State of Current Research

Sandra Barker and Aaron Wolen’s review of animal-assisted activity studies highlights key areas of investigation for human-animal bond research. They report numerous studies where pet ownership leads to healthier physiological outcomes such as lower mortality rates in cardiovascular recuperation from heart surgery, lower physiological stress responses, and increased physical activity [5]. They show how benefits such as these can be explored in relation to increasing the quality of life for those with dementia and AD, describing how the presence of animals has been found to reduce irritability in nursing home residents. In the context of home care, Connell, Janevic, Solway, and McLaughlin (2007) describe decreased agitation, less pacing, more social behavior, and a smaller need for physical restraints in care recipients with cognitive impairments like dementia and AD when animals are present[6]. In short, animal assisted activities improve quality of life (QOL).

Part of improving the QOL for a person with dementia and AD involves keeping that person occupied. Cohen-Mansfield et al. (2010) studied which activities are most effective, most often refused, and most appropriate for engaging residents of nursing homes. Twenty-five different kinds of stimuli were presented in broad categories: live social, simulated social, music, work-related, and self-identity stimuli. Live social stimuli reflected active social behavior with a living thing such as an animal. Simulated social activity involved interaction with a robotic pet or doll. The music stimulus involved listening to different kinds of music. Work-related stimuli were task based, such as filling envelopes. Self-identity stimuli were determined by a questionnaire and reflected the choices of the resident.

Live social stimuli were found to engage participants for the longest duration[4]. Live social stimuli included one-on-one conversation time with a research assistant, interaction with a live baby, and interaction with a pet. The study also looked at engagement between those with comparative levels
of cognitive functioning. Those with higher levels of cognitive functioning were also more likely to be engaged by work-related tasks. Participants with lower cognitive functioning had a higher stimulus acceptance, meaning they were more willing to engage with a variety of stimuli. They were less choosy about what to interact with. However, for both groups live social stimuli were widely accepted and had the greatest time of active participation.

The impact companion animals may have for caregivers as well as care recipients has been an important focus of research. Dementia changes the dynamics and routines of a household. The caregivers may feel stressed with the added responsibility they now have to care for their loved one. They may also experience feelings of frustration, despondency, and isolation [7]. A companion animal may provide the affection, attention, and social outlet caregivers need to help mitigate these feelings.

Baun and McCabe also provide guidance about when a companion animal can be introduced to someone with AD. The animal will require time to bond with the caregiver and the care recipient, and this should be done early in the disease progression when the recipient has a consistent pattern of interactions. Depression can often be present in dementia and AD sufferers. Baun
and McCabe’s study shows that the presence of a companion animal, specifically birds, lessens depressive symptoms at the onset.

The impact of dementia on the relationship between pets and their owners is explored by Connell et al. (2007). While having less time to spend with the pet was the only negative change reported by the caregiver of the pet/owner relationship, some care
recipients lost patience with their pets causing the pet’s behavior to change toward the recipient. However, the authors found that “more positive than negative responses were evident when caregivers described changes in their own relationship with their pets” [6]. Some relationships were actually strengthened between owners and pets. The authors point to advantages of pet ownership for families facing dementia, such as research indicating dogs could be trained to provide some supervision for those with dementia, maintenance of a walking program, and companionship.

An important study of the use of therapy dogs and cats in nursing homes cautions that programs are often not “goal oriented, and an evaluation of the goals is often unclear” [8]. This study focuses on the role of aquariums in improving QOL in nursing homes. Unlike most pet therapy programs which must be supervised in case of any inappropriate behavior
from the therapy animal or the resident, aquariums require little attention from staff to maintain and also little to no direct supervision. The authors cite several benefits to including an aquarium in a nursing home with dementia units. Most
strikingly, they found that care recipients, after being exposed to the aquariums, had a significant increase in nutritional intake because the movement of the fish drew the attention of care recipients who were previously irritable or lethargic at meal times. The recipients were calmer and more attentive[8]. This allowed caregivers to feed them more effectively.

Areas for Future Investigation

Many of the population samples for human-animal bond research are convenience samples. How might a study be designed to be truly
randomized and thus more diverse? [5]. How might studies be designed to answer this? How can extraneous variables be more tightly controlled?

Baun and McCabe (2003) note that a dog could be trained to provide some supervision for those with dementia and/or AD. How might a service dog be trained to recognize dangerous behaviors in a person with dementia and/or AD? If a dog is supposed to look for variance from a routine, how early would a service dog have to be introduced to help supervise?

Cohen-Mansfield et al. (2010) suggest several avenues for research regarding stimuli for residents with dementia. The authors suggest that various stimuli should be available and tailored for the resident. What effect would prolonged, repeated exposure have for the acceptance of the stimulus? Would a variety of animals in the nursing home or dementia unit (such as aquariums, bird cages, visiting therapy dogs and companion animals) be beneficial? Is there a threshold where too much animal exposure is possible?

Edwards and Beck (2002) note that their study measured the quantity of nutritional intake, but that it did not account for the quality of that intake. They suggest that future research incorporate both measures. How might a study be modified to include both measures of nutrition quality and quantity?

Key Resources

Barker and Wolen’s article analyzes the findings of studies for human/companion-animal bond research. The scope of the article is large, covering populations from children to the elderly. It also includes studies on physical activity for those with psychiatric and metal disorders. Specifically pertaining to dementia and Alzheimer’s disease, the authors describe studies reporting improved mood, decreased agitation, and weight gain in geriatric patients with dementia disorders. One study found that eating in the presence of an aquarium might have been responsible for weight gain (weight loss is often a problem for those with dementia and AD).

Mara Baun and Barbara McCabe provide a thorough overview of the effects and symptoms of dementia, specifically dementia of the Alzheimer’s type (DAT). They note that in DAT cases there are two victims, the patient and the caregiver. The researchers propose that companion animals can be beneficial for the health and happiness of both the patient and the caregiver. Much of the article is devoted to describing the stages of DAT and how at each stage companion animal intervention might play a role to benefit both patient and caregiver.

Cohen-Mansfield et al.’s study investigated if and what kinds of stimuli could elicit a response from nursing home residents with
dementia. Residents were presented with a variety of stimuli including live social stimuli, simulated social stimuli, music stimulus, work related stimuli, and a self-identity stimulus. The most effective stimuli were the live social interactions. Live social stimuli included a live baby, one-on-one conversation time with one of the researchers, and a pet. While not explicitly about the human-animal bond, this article provides in-depth explanation of how someone with dementia may be most effectively engaged in activity.

This resource investigates if pets are a positive or negative factor in a household where one of the spouses is suffering from dementia and the other spouse is the primary caregiver. Largely, pets are reported as being a positive factor for the caregiver. Pets contribute by helping the caregiver stay active and social, providing a source of comfort, as well as companionship. For the care recipient, however, the results are mixed. Some recipients report the pets as comfort giving companions, while others lose
patience with their pets more quickly than they once did. The authors also outline the limitations of their study and provide areas for future exploration.

Dogs and cats have been present in nursing homes for many years either in a ‘mascot’ role or as visitors for activities or therapy. This study investigates the role that fish aquariums may play in improving Alzheimer’s patients’ nutrition intake. Weight loss is a serious concern with AD because it is seen as an indicator of increasing severity and mortality. The study compared the nutritional intake of residents in three different nursing homes. There was no significant difference between the nutritional in take of the residents of the nursing homes before the aquariums were added. After the aquariums were added all three facilities showed a significant increase in nutritional intake.